Wed | Nov 25, 2020

Hike in hospital fees to hit insurers

Published:Monday | August 13, 2018 | 12:00 AMAvia Collinder
A section of the University Hospital of the West Indies is seen in this August 16, 2017 file photo. The hospital is Guardian Life's largest biller. The insurance company has seen a spike in payouts to hospitals in the past two years and is projecting that will rise with the doubling of public hospital fees for insured persons that took effect August 1, 2018.

Arising from the increase in user fees in public-health facilities on August 1 for individuals who have health insurance, local insurance providers say that they expect the annual payout to local hospitals to increase.

Already, these charges have been trending higher yearly with increased usage of public hospitals since 2016 when the Ministry of Health, adjusted the fee policy to allow hospitals to collect from persons with insurance.

The report from one insurer is that the payouts to hospitals now top $400 million annually and are expected to trend higher, now that the health ministry has doubled charges for some services.

Top insurance provider, Sagicor Life Jamaica, had not followed through on promised comment for this story up to press time.

However, Guardian Life Limited, which is the second largest life insurer led by president Eric Hosin, told the Financial Gleaner that the dollar limit placed on health policy benefits would effectively put an upper limit on its exposure to the new charges.

The uninsured still use hospital facilities at no cost. On August 1, new fees took effect for non-residents, private patients and patients with health insurance in Jamaica. These persons are now required to pay $3,000 for general medical visits, up from $1,500.

Visits to speciality clinics will now $7,500, up from $3,500; while ICU services increased to $10,600 per day from $5,000.

In general, insurance companies disclose that they are billed for hospitalisation, surgery, medical visits, diagnostics (lab and x-ray), prescription drugs, maternity, dental and other services used in the public health system.

Guardian Life said that prior to the 2016 policy change, its payouts for hospital care was $300.3 million. The year after the change, payouts climbed to $434.45 million.

So far this year, between January and July, it has paid over $297 million to hospitals. That figure, when annualised, suggests that Guardian Life could end up paying out half-billion dollars for the year.

Since 2016, around 98 per cent of costs have been split almost equally between general hospitalisation costs and maternity charges, with diagnostics, medical visits and other services accounting for the rest.

Guardian Life says the teaching hospital, University Hospital of the West Indies, is its biggest biller.

As to the expected increased from the doubling of health facility charges, the company said its dollar limit for services would effectively put a cap on any increase.

"Benefits have a dollar value limit on each, hence our payment will not exceed the limit of the benefit applicable to the particular company/cardholder," the company said via email.

Citing an example, the insurer said where a doctor's visit is covered for up to $1,800, but the doctor has increased charges to $3,000, the policy payout would remain capped at $1,800 for the visit.